by jim zouch
A young female distance runner reminded me of the importance of discussing diet, sleep, stress and the menstrual cycle/or absence of, in a recent presentation for acute pain in the shin. Often patients, particularly runners are quite aware of their running mileage and the changes in their running volume that might be linked to injury. Less frequently are patients aware of other factors that may contribute to an injury such as a stress fracture.
This was the case in a young runner who presented at the start of autumn following a few weeks of shin pain. She had reported her running volume had been really consistent and had not experienced an injury. Because of these factors, she had decided to continue to run through the pain believing she hadn’t sustained any major damage. When I mentioned that other factors may contribute to running injuries, she volunteered that she had been a little more tired than usual and had recently changed her diet to reduce calories. I mentioned that absence of a menstrual cycle may be a symptom of what we term RED-S or Relative Energy Deficiency in Sport – a name given to describe a potentially serious syndrome that essentially results from a lack of nutrition to support the body’s demands.
She volunteered that she hadn’t experienced a menstrual cycle in the last three months. We discussed the various ways that relative energy deficiency can affect many of the body’s functions and I directed her toward some further reading. In this situation we discussed the stress fracture may be a symptom in itself and that it was important to address any potential issues with her diet, sleep and overall health in the first instance.
We decided on a course of non-weight bearing because of her immediate pain with walking and referred her for a discussion with a Sports Medicine doctor to discuss some further investigations. I also recommended she discuss her eating habits with a registered dietician. For the purpose of the article and client confidentiality, I’ve kept the discussion brief but in reality, once we had identified there were some signs and symptoms of RED-S most of our appointment time was allowing this patient to discuss her issues in a safe environment.
As a clinician it reminded me how important it is to create an environment where a client feels comfortable to share all of their issues.